Development of cost-effectiveness management tool for Korean Medicine hospitals in Korea

摘要

Purpose: From the point of view that high medical costdoes not guarantee high quality of medical care, we needmeasures to manage cost-effectiveness. In Korean Medicinehospitals, the elderly population is more than 70% of thepatient composition and medical cost is increasing by 15%every year. However there is no measure developed to managecost-effectiveness. We developed a Korean Diagnosis RelatedGroup-Korean Medicine (KDRG-KM) in the area of KoreanMedicine (hospitalization) to use as a tool to manage quality ofmedical care and to compare case-mix adjusted inter-hospitalcost-effectiveness. The aim of this study is to assess clinicalsimilarity and the homogeneity of resource use in the groupsof KDRG-K M.Methods: We used claims of 2012 data from KoreanMedicine hospital that were submitted to HIRA (Health InsuranceReview & Assessment Service).We performed T-test andF-test on occurrence frequency and average medical cost ofdisease, procedures, age and severity. The results were usedas reference in the classification determination process, underthe guidance of clinical specialist panel(including 8 specialistacademic association).Results: Based on KCD (Korean standard Classification ofDiseases), diseases were categorized into 27 groups and procedureswere divided into 11 groups with the standard oftype of consultation(Korean Medicine hospitalization or othermedical institution hospitalization) and type of procedures(acupuncture, moxibustion and cupping). In consideration ofthe fact that elderly patients are the majority, age is splittedup at 65-years-old, 80-years-old. Therefore, the final numberof total groups is 234. KDRG-KM has 66.5% of R-squared (R)value.Conclusion: The KDRG-KM could be used as inter-hospitalcomparison tool for improving the quality of medical care. Italso makes it possible to use medical cost more efficientlyby securing homogeneity of resource use. In particular, theintroduction of age splits makes it more efficient to managethe medical cost and improve quality of medical care for theelderly.